Models of Abnormality

﻿You will already be familiar with the idea of 'models' from your AS Level studies, so you know that different psychologists might approach the same problem in very different ways. Some might look at the social factors behind the behaviour, others cognitive factors and some the biological factors. Before we can even begin to decide on how to treat mental illness in our society, we need to work out what we are actually talking about! As you will see, even this preliminary task is extremely controversial!﻿

﻿Assignment 1 - what is 'abnormal'?﻿

﻿Look at the picture of One Direction on the right. All of them are admitting to some unusual behaviour... but which would you diagnose as 'abnormal'?

For each band member, decide if the behaviour is abnormal or not. Write a brief justification (3-4 lines for each person) of your views.﻿

Definitions of abnormality

There are 4 different methods of defining abnormality which you need to know. Different definitions may be more effective for different situations. Listen to this podcast, then read the descriptions below...

Deviation from statistical norms

This definition asks one simple question:

How unusual is the behaviour being displayed?

If it is statistically unusual, then it is classed as abnormal. For this reason, the explanation is sometimes known as 'statistical infrequency'.

Using a normal distribution (see above), we can identify people who are a long way from the mean.

However, an obvious problem here is that this doesn't take into account whether the behaviour is desirable or not (e.g. is a high IQ 'abnormal'?)

﻿Violating social norms﻿

Societies and cultures all have a number of unwritten rules of behaviour which most people follow. These are called social norms.

For example:If someone does not say thank you if you do them a favour, you might feel that this violates a social norm of being polite.

In extreme cases, violating social norms could allow a diagnosis of abnormality.

However, social norms may change over time and between cultures and areas (or even families). Who is to say which set of norms we use as our baseline?

﻿Deviation from ideal mental health﻿

Are 'normal' people always this happy?

﻿Rather than look at what is 'abnormal', we could start by deciding what is 'normal' and then find people who do not display 'normal' characteristics. Defining normality is, of course, just as hard as defining abnormality, but Jahoda (1958) included:

Positive view of the self

Capability for growth and development

Autonomy and independence

Accurate perception of reality

Positive friendships and relationships

However, do normal people exhibit all of these all the time? I certainly don't! Also, these definitions of normality are very ethnocentric.﻿

﻿Failure to function adequately﻿

Most people who ask for psychological help are suffering from distress. Rosenhan and Seligman (1989) suggested that this could be used to help define abnormality. People failing to function may display:

Suffering

Maladaptiveness (danger to self)

Vividness & unconventionality (stands out)

Unpredictably & loss of control

Irrationality/ incomprehensibility

Causes observer discomfort

Violates moral/social standards

One problem here is that sometimes these behaviours could be helpful or even enjoyable! Extreme sports could be maladaptive. Vividness can help to make people successful etc.

﻿Assignment 2 - applying definitions to the real world﻿

﻿﻿﻿Look back at the picture of One Direction. Which definition of abnormality would be most appropriate for each of their behaviours? Now fill in this document with a detailed argument for the three cases given.﻿﻿﻿

Hopi Indians have no word for ‘depression.’ Does this mean it doesn't exist in their culture?

Assignment 3 - Definitions factsheet

﻿Tools for diagnosing abnormality﻿

We might know that someone is behaving abnormally, based on the definitions above. But how do we know which condition they might have? How can we diagnose specific mental illnesses? To help them with this, psychiatrists and psychologists use specialised books, or manuals.

DSM - Diagnostic Statistical Manual of mental disorders

A manual published by the American Psychiatric Association (APA) which contains a guide to the diagnosis of mental disorders. DSM contains descriptions, symptoms, and other criteria for diagnosing mental disorders. In 2013 the 5th edition was published (the first was in 1952). This is probably the most widely used manual worldwide, although it is not without its controversies. See this link on the DSM website for more.

ICD - International Classification of Diseases and Related Health Problems

Now in it's tenth edition, this is a ﻿system used by physicians and other health care providers to classify and code all diagnoses, symptoms and procedures recorded in conjunction with hospital care in the United States. It therefore covers a much larger range of conditions than just mental health disorders. It works in a similar way to the DSM, but the disorders are coded (e.g. A00-Z99). See this link for more.﻿

CCMD - Chinese Classification of Mental Disorders

Published by the Chinese Society of Psychiatry (currently in its third edition), this follows the same format as the ICD and DSM for most disorders but also includes about 40 'culturally-related' diagnoses, some of which may not be mentioned in the DSM or ICD. (see below for more on 'culture-bound' disorders)

This picture illustrates how the diagnosis of one condition - autism - has changed over time as the successive editions of the DSM have been published. It is a good example of the way that diagnoses of conditions can change over time (see below for more on this), as a result of changes in scientific or cultural ideas.

﻿Problems with defining abnormality﻿

﻿One major problem with defining what is abnormal is that the definition will vary between different cultures. Some disorders are culture-bound (they only occur in certain cultures and are unheard of in others). For example, anorexia may only occur in Western countries, so may be a culture-bound disorder. Some of these are fascinating - see this list for the top ten weirdest!

There are no universal indicators of mental illness! In other words, everyone is different and each sufferer will have their own unique combination of symptoms. It is therefore impossible to find one shared characteristic which can be defined as 'abnormal'. The DSM uses checklists of behaviours, which patients are expected to show some of but not all.

Our ideas of mental illness have changed over time! Homosexuality was included in the early versions of the DSM, but in most countries it would now be unthinkable to class this as a mental illness. See here and here for more.

All of these points question the validity of any definition of abnormality. Are we really measuring what we think we are, if it changes so often!﻿

This video also looks at some of the problems associated with defining and diagnosing abnormality.

Problems with diagnosing abnormality

Would this label be helpful to a sufferer?

Reliability of diagnosis? Would different clinicians using the same diagnostic systems agree on the diagnosis
given to an individual? Given that diagnosis relies on the subjective interpretation of the therapist, their opinions may vary. Beck et al (1962) found that agreement on diagnosis for 153 patients between two psychiatrists was only
54% - there was very low reliability.

Validity of diagnosis? As well as the point about validity of definitions (above), we can also question the validity, or accuracy, of the diagnosis. If psychiatrists' diagnoses have low reliability (e.g. the Beck et al evidence above), then presumably they can't be very valid either! They can't be diagnosing the thing accurately if they disagree about what it is! The Rosenhan study which you looked at in your AS Level is another good example.

Also, we can question the usefulness of a diagnosis of abnormality.Whilst a diagnosis may be useful is allowing someone access to specialist help which they would not otherwise have had,﻿it can also be very harmful. There is a social stigma around mental illnesses, which can lead to ethical (protection from harm) problems such as labelling. ﻿

Bullet point 2- Models of abnormality

﻿The Biological model of abnormality﻿

﻿Key assumptions of the medical/biological model﻿

﻿The biological model believes that all psychological disorders have a physical cause (for example genetics, anatomy, biochemistry etc). The model believes that there must be something in the structure or function of the brain which is responsible for causing psychological problems.

One example of this might be the dop﻿amine hypothesis for schizophrenia. This suggests that excess dopamine (a neurotransmitter used parts of the brain) is a factor in creating the symptoms of schi﻿zophrenia.

Read about the medical model in more detail on the Simply Psychology website here. Now listen to this podcast.﻿

﻿Applications of the model﻿

﻿The medical model is the dominant model in the diagnosis and treatment of most (but not all) psychological conditions....

Many treatments are biologically-based (drug therapies are the most common treatment, but surgery and ECT may also be used depending on the condition). ﻿Drugs may be effective﻿ but ﻿often have side-effects﻿.

However... the effectiveness of medical treatments does not guarantee that the disorders have a medical origin.

The model is not relevant to all psychological conditions (for example eating disorders)

The model focuses on the physical symptoms, rather than the psychol﻿ogical thoughts and feelings of patients.﻿

﻿GENERAL EVALUATIONS OF BI﻿OLOGICAL EXPLANATIONS﻿

﻿﻿· Biological explanations are reductionist as they focus on only biological factors such as chemicals or hormones and ignore psychological factors. · Biological explanations are deterministic because they ignore the individual’s ability to control their own behaviour.

· Biological explanations are not consistent with the success rate for cognitive therapies. Also the success of combination therapies suggests more than one cause. ﻿﻿· They can, however, be the easiest explanation for the patient to accept (as it takes the blame away from them and their actions for their condition)﻿﻿

ReDUCKtionism... geddit? geddit?

﻿The points above can be used for ANY essay on the biological model (providing you then relate them to the condition you're discussing)... so LEARN THEM!﻿

﻿The Behavioural model of a﻿bnormality﻿

﻿Key assumptions of the behavioural model﻿

﻿You should remember Behaviourism from your AS work. If you can't remember the key ideas such as operant and classical conditioning, then go back here and re-read the AS introduction page first.

Behaviourists believe that all behaviour (good or bad) is learned through our interaction with the environment. This applies to abnormal behaviour as well, so a psychological condition is simply a learned response to a particular set of environmental stimuli.

For example, phobias may arise from classical conditioning, where we come to associate a stimulus (e.g. dogs) with a response (e.g. fear) following a negative incident.

Symptoms could then be positively reinforced, for instance with attention and sympathy from friends and family. Social learning theory could play a part too.

The flip side of this is the belief that 'anything that has been learned can be unlearned', in other words behaviourists believe that by changing the environmental conditions, we can treat psychological conditions effectively. This clearly has implications for the treatments that it will suggest. Listen to this podcast to take your understanding further.﻿

﻿Applications of the model﻿

The model is a ﻿simple and effective method of explaining and treating some psychological conditions﻿ (such as phobias)

However, for others it seems to be ﻿over-simplistic and reduce a complex condition (such as schizophrenia) to simple processes of reinforcement﻿. This seems wrong.

Therapy is often cheap and easy to perform (e.g. systematic desensitisation for phobias)

There can be ethical issues with some treatments, which expose people to stressful environments.

﻿Psychodynamic models of abnormality﻿

﻿﻿Ass﻿umptions of the psychodynamic model of abnormality﻿﻿

﻿Again, if you can't remember the basic ideas of the Psychodynamic approach to Psychology from AS, then re-read them here first. Freud's personality theory of the id, ego and superego are crucial to his explanations of mental illness.

Disorders arise from conflict between the id, ego and superego. For example, if the superego becomes dominant over the other two, Freud believed that the person would suffer anxiety.

﻿Applications of the﻿ model﻿

﻿Psychodynamic therapy was very influential in the first half of the 20th century. It involves the use of psychoanalysis, where the therapist uses techniques such as dream analysis, free association and hypnosis to explore the patient's unconscious mind.﻿

Patients are ﻿not placed in institutions, and therapists are supposed to be compassionate and understanding, where no judgement is made of the patient﻿.

However, ﻿the therapy has not been found to be particularly effective, despite being a time-consuming and expensive process﻿. Therefore it is limited in its usefulness.

﻿Cognitive models of abnor﻿mality﻿

﻿Assumptions of the cognitive mo﻿del of abnor﻿mality﻿

﻿As you will remember from the AS studies on cognitive psychology, this approach assumes that a person's thoughts (or cognitions) are responsible for our behaviour. Therefore:

It is not our experiences, but how we think about our experiences, which determines our behaviour and our mental health.

Faulty or irrational cognitions are the cause of mental health problems. They can cause distortions in the way that we see the world.

Therapy should attempt to restructure or replace faulty cogntions with more healthy ones.

Assignment 5 - Models factsheet

Assignment 6 - Section A and C Questions

Have a go at these questions from memory.

Paper 3 Section A question:1. (a) Explain what is meant by ‘classifying abnormality’. [2](b) Describe one way in which abnormality is classified. [4]3. (a)Describe the main features of one model of abnormality (6) Try to write at least half a page for this question

Bullet point 3 -Treatments of abnormality

﻿Treatments using the medical model﻿

﻿Remember that the medical model believes that all psychological disorders have a physical cause. They therefore believe that psychological problems can be addressed by altering biological activity in the brain. Types of biological treatments could include:

Drugs

ECT

Surgery﻿

﻿How do dru﻿g treatments work?﻿

﻿Brain cells (neurons) communicate with each other at junctions called synapses, using chemicals called neurotransmitters.

In normal functioning

A nerve impulse reached the end of the axon.

Packets of neurotransmitters called vesicles are released and the neurotransmitter diffuses across the synapse.

The neurotransmitter binds to receptors on the other side of the synapse, causing a nerve impulse to begin again in the next neuron

Drugs...

... alter the levels of neurotransmitters, so affect how the synapses work.

﻿A closer look at a synapse﻿

﻿Behavioural treatments of abn﻿ormality﻿

﻿Remember the key assumptions of the behaviourist approach from the section above. Behaviourist treatments try to reverse this process, weakening negative associations and behaviours and strengthening positive ones.

Examples of behavioural treatments which use classical conditioning include flooding and systematic desensitisation (both of which are used to treat phobias).

Examples of behavioural treatments which use operant conditioning include behaviour modification and token economies (which have been used in a number of settings, from treating disruptive students in school to encouraging pro-social behaviour in schizophrenics).﻿

﻿Psychodynamic treatments f﻿or abnormality﻿

﻿Key ideas of psychodynamic treatments include:

These aims can be achieved by using therapies such as dream analysis, free association or hypnosis.﻿

A good example of this process in action is the strange case of Anna O, one of Freud'﻿s patients. Read more about her here.

The classic view of psychoanalysis. A patient reclines on a couch and is encouraged to talk about their deepest feelings by the therapist.

﻿Therapists should be...﻿

﻿Compassionate

Understanding

Non-judgemental﻿

﻿﻿Cognitive treatments for ab﻿normality﻿﻿

﻿Cognitive therapies for abnormality are usually combined with a behavioural element (so as well as trying to change patients' thoughts, they also try to change their behaviours). There are two major types of CBT:

Albert Ellis' Rational Emotive Behaviour Therapy (REBT)

Aaron Beck's Cognitive therapy

Although they have some differences in their procedure and approach to therapy, they both have the same basic outlook. They are trying to replace faulty or irrational thought processes with healthier ones. ﻿

The ABCDE of Ellis' therapy

Beck's cogntive triad

Studying Abnormality - Prospective vs Retrospective studies

Retrospective studies

﻿Retrospective studies begin after the outcome is already known (for example the person has developed a psychological condition). The study then looks back and examines exposures to suspected risk or protection factors in relation to their condition.

MOST studies of abnormality which involve cohorts (large groups of patients) tend to be of this type.﻿

Retrospective studies are much less time consuming, as we do not need to track people for years.

It is therefore much easier to find and investigate large, representative samples.

Much more open to bias and confounding variables, as we are retrospectively explaining, rather than predicting.

It is therefore had to ever be certain of exactly what the causes are.

Prospective studies

A prospective study, in contrast, monitors a population for an outcome that has not happened at the start of the study, to determine how often it occurs in that population (e.g. following the children of schizophrenic mothers to see if they themselves develop schizophrenia). This allows us to observe risk and protection factors as they happen, so we have a much clearer idea of the real causes of the condition being studied.

Reduced chance of bias and confounding variables, as there is less need to try to look for causes of events which have already happened.

Easier to find causal relationships, through testing predictions.

VERY time consuming, and therefore also often expensive, as participants need to be followed for years.

End of sectio﻿n essay writing exercise - introducing Section B

Although you've written Section B 'describe' essays for some of the sections above, in reality you won't be asked this in the exam. You will get an essay on the whole section. The essay will have two parts, a 'describe' section and an 'evaluate' section. We'll now start looking at the 14b) 'evaluate' question as well.14 a) Describe how one psychological model has been applied to abnormality. [8]14 b) Evaluate how﻿ one psychological model has been applied to abnormality a﻿nd include a discussion of competing models. [12]

First read this document, which covers the skills that we want you to learn when approaching these questions. In summary, you need to try to mention a range of information in question a), so try to mention things from all three bullet points in the specification (so here, something from each of the three approaches). For the question b), try to evaluate using issues and debates (same ones as from AS level). On this page, issues such as reductionism, determinism, ethics, data collection methods, scientific-ness, objectivity and other have been mentioned. Use these in your evaluations! Remember to use a PEE format if you find it helpful.

One final point. Make sure you answer the specific question asked! The 2 b) question will always have a little extra requirement in it, where it will ask you to focus your discussion on one specific area or issue. Here is it 'competing models'. At least a paragraph should consequently be devoted to comparing and contrasting different models of abnormality.

Generic mark schemes are given below. Read them carefully before you start writing and make sure your essays fulfill all the requirements. Please submit your essays through the form on the home page.

End of se﻿ction essay writing exercise - Introducing Section C

Section C in your exam always consists of two questions, one 6 mark recall question and one 8 mark application question. There are always two of these types of question, an﻿d you need to choose one.

You are a practis﻿ing psychotherapist and you know how to treat patients and the underlying causes of disorders. One of your patients is a male who has a fear of women.

15 a) Describe the main features of psychotherapy. [6]15 b)﻿ Suggest how you would use psychotherapy to help your patient to resolve his fear of women. [8]﻿

The first question is a straightforward recall question. This is the longest question you will get which could focus on just a single theory. You need to write about half a page, so a simple revision check is to make sure that you can write half a page of description about every idea/theory/study that is specifically mentioned in the specification.

The second question allows you to be creative. There is no single right answer. All you have to do is give practical and specific ideas for how you might implement the theory you have described in the first question into the scenario they give you. About a page should be a good length. Here you have to suggest how you would use psychotherapy to treat the patient. You therefore need to make sure that you are specifically referring to ideas of psychotherapy, and to the condition given in the question. It takes some getting used to writing this way, but it is an area that, with a little bit of practice, you will be able to do very well on.

Have a go at the questions above. Please submit your essays through the form on the home page.

Revision

Extension

Now THIS is a synapse!

The introduction to synapses above is fine for A level, but if you want to be totally blown away by just how complex these communication devices are, then have a look at some of this incredible new research described here and here. Then remember that you have trillions of these in your brain!